Healthcare Provider Details

I. General information

NPI: 1194707349
Provider Name (Legal Business Name): JENNIFER R CHAPMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 01/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WEST AVE S
LA CROSSE WI
54601-8806
US

IV. Provider business mailing address

700 WEST AVE S
LA CROSSE WI
54601-4783
US

V. Phone/Fax

Practice location:
  • Phone: 608-392-9883
  • Fax:
Mailing address:
  • Phone: 608-392-9883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number47269
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: